Distal Interphalangeal Joint Arthritis
What is distal interphalangeal joint arthritis ?
Distal interphalangeal (DIP) joint arthritis is wear of the cartilage in the last joint of the fingers, the joint just before the nail.
Like all forms of osteoarthritis, it results from progressive cartilage breakdown, leading to painful bone-on-bone contact.
It presents with pain, progressive joint stiffness and characteristic bony enlargements known as Heberden's nodes. Mucoid cysts may develop at the base of the nail, causing nail deformity. It predominantly affects women over 50 and can involve several fingers at the same time.
When is surgery needed ?
Conservative treatment is always offered first:
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analgesics and anti-inflammatory medication during painful flares
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a rest splint
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corticosteroid injections to settle inflammatory episodes
Surgery is considered when these measures no longer provide adequate relief, when deformity becomes functionally limiting, or when mucoid cysts are painful or causing significant nail deformity.
How is the procedure performed ?
The procedure is performed under regional anaesthesia on a day-case basis (the patient goes home the same day).
The technique used is distal interphalangeal arthrodesis: the arthritic joint is surgically fused in a slightly flexed functional position, permanently eliminating pain from joint movement.
The worn joint surfaces are prepared and held together with internal fixation hardware (screws, wires or specific implants) while bone fusion consolidates.
Any associated mucoid cyst is excised at the same time.
What is the recovery ?
A splint immobilising only the tip of the finger is worn for six weeks while bone fusion takes place. The remaining fingers are free and mobile throughout, allowing near-normal use of the hand.
Wound care is carried out during the first weeks.
Physiotherapy is then prescribed to restore overall hand mobility and grip strength.
What are the risks ?
Distal interphalangeal arthrodesis is a reliable procedure with a high rate of pain relief. Risks include:
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non-union (failure of the bone to fuse) which may require revision surgery
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wound infection
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suboptimal fusion position
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nail damage if an associated mucoid cyst has affected the nail matrix prior to surgery